Term
40-60%
No. 40-60% is the max delivery for a Simple Mask |
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Definition
You are utilizing a Simple Mask to deliver O2 to a patient and you have set the flow meter at 8 Lpm. Because this is within the 6-10 Lpm range, what percentage of delivery do you know you are giving to your patient?
If you turn the flow up past 10 Lpm, will it increase the percentage of delivery? |
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Term
21% (room air is 21% O2)
60-70% |
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Definition
NR Question: You are using a Bag Valve Mask to ventilate a patient. What is your O2 delivery percentage without connecting supplemental oxygen?
What will it be with supplemental Oxygen connected? |
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Term
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Definition
| You are supplying a patient with supplemental oxygen via non rebreather mask. What percentage oxygen delivery can you expect to achieve at 12-15 lpm? |
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Term
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Definition
| What percentage of oxygen delivery can be achieved with the Venturi mask by adjusting the amount of air entrainment? (what is the maximum percentage you can expect?) |
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Term
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Definition
| What is the treatment of choice for CHF with pulmonary edema (also asthma, COPD)? |
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Term
| It can cause a drop in Blood Pressure |
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Definition
| What is the danger of CPAP that must be continually monitored? |
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Term
| It keeps the alveoli open (splinted), so now when you breathe in, you over pressurize the system a little bat and that places pressure on the heart, causing BP to drop. |
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Definition
| What is the mechanism by which CPAP causes a drop in blood pressure? |
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Term
| pH goes down, respirations go up |
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Definition
| What is it (in general) about our respiratory system that classifies it as a negative feedback system? |
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Term
The Medulla
The Cerebellum |
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Definition
Your basic respiratory drive (involuntary) comes from where in the brain?
Voluntary control of the respirations are altogether different and controlled by what other part of the brain? |
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Term
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Definition
In a state of repose, our bodies are using what percentage of our calories to breathe?
What is the percentage for a typical patient with COPD? |
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Term
Metabolic (amount of pH in CSF)
Behavioral
RAS
Medullary |
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Definition
| Name the four factors that are responsible for the control of our breathing? |
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Term
Central: are located on the ventrolateral surface of medulla oblongata and detect changes in pH of cerebrospinal fluid. (These are sensitive to pH and CO2).
Peripheral: consists of aortic and carotid bodies. (Aortic body detects changes in blood oxygen and carbon dioxide, but not pH, while carotid body detects all three.) |
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Definition
Where are the chemoreceptors that affect breathing rate and what two categories are they broken down into?
What do they monitor / respond to? |
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Term
| 7.35-7.45 = Slightly Alkaline |
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Definition
| The human body falls a little above center in regard to its pH. What is our normal range and does this make our blood - acidic or alkaline? |
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Term
| pH Bond. In order for enzymes to work, the pH balance must remain within it's limit. |
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Definition
| Much of what we transport in the blood is dependent upon what? |
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Term
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Definition
What component of our makeup can take two things and create something else (as a compound) or can neutralized something by combining it with something else?
Hint:commonly, to eliminate pet odor, this takes the particles that create the smell and combine them with something else to create a neutral (non smelling) product. |
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Term
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Definition
What law can be illustrated by a balloon that gets bigger as it rises (more volume due to less torr pressure on the outside) while that same balloon underwater gets smaller and smaller?
States that if a gas is held at a constant temperature the volume is inversly proportional to the pressure. i.e. Compressing a gas to half it's initial volume doubles it's pressure? |
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Definition
| What law states that the amount of gases in a fluid is dependent upon the torr pressure above the fluid (such as in a cola)? |
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Term
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Definition
| Which law states that if a gas is held at a constant pressure, the volume is directly proportional to the absolute temperature. i.e. Heating a gas to double it's original temperature doubles it's volume? |
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Term
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Definition
| This law states that the total of the individual weights of the gases in the environment make up the sum total of the atmosphere's weight. |
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Term
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Definition
The sum of the pressures of all the gases present in the atmosphere?
What is this pressure at sea level? |
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Term
| Greater volume of water vapor = higher torr |
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Definition
| What will high humidity do to the Torr pressure? |
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Term
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Definition
| What is defined as movement of gas across a membrane? |
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Term
Ventilation. (Mucous plugs in the airway)
Two Fold. Cannot move air out and cannot respirate at the capillary / alveolar interface. (no gas exchange - just holes where the alveoli should be) |
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Definition
Why does a COPD patient have trouble breathing?
In Emphysema, what is the problem with their breathing? |
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Term
Increase hydrostatic pressure (pulmonary edema)
Decreased Oncotic pull (liver disease, etc)
Increased vessel wall permeability (histamine release)
Obstruction of a lymph channel (parasite or blockage) |
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Definition
| ALL Edema can be classified under one of four categories. What are they? |
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Term
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Definition
| Lack of ketones due to a poor diet / lack of protein. The body burns fat, which produces more acid, creating a state of metabolic acidosis. |
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Term
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Definition
| Brought on by a lack of insulin and resulting inability of sugar to get into the cells. The body begins burning fat for energy which produces excessive acid and creates a state of metabolic acidosis. |
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Term
Aspirin Overdose
Diabetic Ketoacidosis
Alcoholic Ketoacidosis
Extreme Exertion |
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Definition
| Name four things that can result in over production of H+ and lead to a state of Metabolic Acidosis. |
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Term
Respiratory = PcO2
Metabolic = bicarbonate level |
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Definition
What normal values will you find aberrant in the case of respiratory issues?
Metabolic Issues?
Hint: PcO2, HCO3, pH |
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Term
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Definition
| You encounter a patient with a pH under 7.35 with a high PcO2, slow respirations who is hypercarbic. What state are they in? |
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Term
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Definition
| What is a key sign that may tip you off that a patient may be in metabolic alkalosis? |
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Term
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Definition
| What kinds of disorders are related to bicarbonate levels? |
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Term
| Consider Bicarb. (we won't do it, but we'll consider it) |
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Definition
| National Registry ?: What does the paramedic do for a child who has overdosed on Aspirin? |
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Term
Sodium Bicarb causes a tremendous spike in CO2
(you have temporarily caused the buffer system to work) |
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Definition
| You are running a code and administer Sodium Bicarb. You note that the capnogram spikes from 16 to 40, then returns to the 16 range. What has just happened? |
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Term
Epinephrine 1:1000
.3-.5 mg s/c |
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Definition
| What is the mainstay drug for respiratory emergency? It is the most powerful drug we have? |
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Term
Breath Sounds
No breath sounds means air isn't moving and will not transport the nebulized medication. |
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Definition
| What must you assess for prior to administering a nebulized drug such as albuterol? Why? |
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Term
Racimic Epinephrine (nebulized epi)
.25-.75 ml via nebulizer |
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Definition
| What drug is specifically used in cases of croup? What is the dosage? |
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Term
Terbutaline (Brethine)
Inhalation or s/c .25 mg |
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Definition
| What drug is indicated in cases of bronchial asthma, bronchospasm and COPD with the additional Beta 2 quality of relaxing the uterine muscles to delay labor? Dosage? |
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Term
Metaproternol (Alupent)
.2-.3 in 2.5 ml of fluid |
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Definition
| What drug is indicated for bronchial asthma, bronchospasm and COPD with the precaution that it drives hypertension and raises the heart rate / produces arrhythmia? Dose? |
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Term
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Definition
What class of drug is a bronchodilator that works by dilating smooth muscle with the side effect of also dilating the smooth muscle of the vasculature?
Hint: any drug ending in "ophyllin" |
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Term
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Definition
| Which of the Xanthines will we see in the field? |
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Term
Atropine
.5-1mg in 2-3 ml of NS via nebulizer |
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Definition
| This drug is an anticholinergic used for bradycardias, bronchial asthma bronchospasm and COPD. Not for acute treatment of bronchospasm? |
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Term
Methylprednisolone (Solu-Medrol)
125-250 mg IV |
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Definition
| This corticosteroid is indicated for treatment of anaphylaxis, ashtma, COPD, Uticaria and spinal cord injuries. It is given because of it's anti inflammatory properties. |
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Term
Morphine Sulfate
2-5 mg IV / 5-15 mg IM |
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Definition
| This drug is indicated for treatment of pain, MI and pulmonary edema. In pulmonary edema, it is used for its smooth muscle relaxing effect and subsequent container enlargement, thus dropping systemic pressure and lessening edema. |
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Term
Furosemide (Lasix)
40-80 mg IV or classically give twice whatever the patient is taking. |
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Definition
| This loop diuretic is indicated for treatment of CHF and pulmonary edema except in patients who are pregnant or dehydrated. |
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Term
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Definition
| How many times do the bronchioles divide down until they reach the terminus of the alveoli? |
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Term
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Definition
| What structure is considered the dividing line between the upper and lower airway? |
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Term
| BP will go down because flow will diminish to the aorta downstream from the occlusion. |
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Definition
| What will happen to your blood pressure in the event of a PE and why? |
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Term
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Definition
| Autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigability. Function can / will diminish toward eventual respiratory arrest? |
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Term
| By diminishing minute volume |
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Definition
| How do Cheyne Stokes respirations harm us? |
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Term
| Intoxicated and breathing slower. Results in respiratory acidosis, which results in somnolence and further respiratory depression which results in eventual death. |
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Definition
| Describe the chain of events that can lead a person from respiratory depression via intoxication to eventual death. |
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Term
Oxygenation: Depth of ventilation
Control of Acid: How fast you ventilate |
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Definition
| If your goal in ventilating a patient is to make them less acidotic, would you ventilate faster or deeper? What if your goal is to oxygenate the patient? |
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Term
1. sympathetic agonist such as albuterol
(Terbutaline is a sympathetic agonist as well that is also used to stop contractions)
2. Iprototropium Bromide – when combined with Proventil = duo neb – they potentiate one another
Ophyll – Xanthines
3. Magnesium Sulfate – dilates the bronchioles (also for Torsades and Eclampsia) |
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Definition
| Three methods of dilating the bronchioles? |
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Term
JVD / CHF = Right Side Failure
Pedal Edema = Right Side Failure
Pink Sputum = Left Side Failure |
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Definition
State whether the following signs / symptoms indicate left or right side failure?
JVD / CHF
Pedal Edema
Pink Sputum |
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Term
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Definition
| Secreting tumor of the adrenal medulla that excretes chatecholamines (epinephrine)? |
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Term
| High altitude cerebral edema |
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Definition
| Anyone ascending above 13,000 feet has a high risk for this potentially deadly condition? |
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Term
| Solumedrol or deymethazone (steroids) |
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Definition
| What two drugs, used in the treatment of HACE (High altitude cerebral edema) must be kept with you if plan to ascend abover 13,000 feet? |
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Term
| Patient has entered the second stage of asthma: inflammation. |
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Definition
| You encounter a patient with a history of asthma who is having difficulty breathing. You administer albuterol per protocol. What do you suspect is the problem with this patient if the Albuterol is ineffective? |
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